Introduction: High velocity trauma is the cause of maximum number of fatality in the younger age group worldwide. In the field of trauma surgery open fractures of the leg remain with the higher complication rate. Treatment options include wound debridement reduction and immobilization with cast, open reduction and plate fixation, external fixation, and IM nailing. Limb reconstruction system (LRS) is a unilateral rail system which consists of Schanz pins, rail rods, and sliding clamps. LRS was considered as definitive management for open fractures. LRS with its modular attachments, it is specifically designed to enable the surgeon to perform simple and effective surgery as it offers rigid fixation of fracture fragments, allows early weight bearing, and reduces the economic burden. Aim: The aim of the study was to determine the efficacy of mono-lateral external fixator LRS for management of the lower extremity long bone fracture (tibia/femur). Methods: A prospective study was carried out where 26 cases of lower extremity trauma (complicated) managed by LRS over a period of 5–6 months. The patients ranged from age 13 years to 67 years. Majority were male and predominant mode of injury was road side accidents. Majority of case were exposed to multiple the surgeries before LRS application. Most of the cases are of infection non-union. All the patients were treated at our hospital. These surgeries were done from June, 2005 to 2007. Any bone fragments that were protruding out we recovered with sterile dressing. The patient were taken to the operating room and treated by pulsed lavage and debridement the wound and splints. In patients, whose bone was exposed, as the wound condition improved the patients were planned for flap rotation. Assessment of quality of regenerate was done by plain radiography and clinical assessment at every follow-up. Final assessment for bone results and functional results was done using Association of the study and application of the method of Ilizarov (ASAMI) score. Results: Among 26 patients, bony results as per ASAMI score were excellent in 73.07% (n=19), good in 19.23% (n=5), fair in 3.84% (n=1), and poor in 3.84% (n=1). Functional results were excellent in 84.7% (n=22), good in 11.5% (n=3), and fair in 3.8% (n=1). All the 26 cases of lower extremity fracture were kept on LRS external fixator for a period of 5–6 months on an average depending on the rate of union, after which the fixator was removed. For 2 patients nailing was done after LRS frame removal. Average time for frame removal was 28 weeks. In most cases union was complete by 7–8 months, the least being 5 months for a tibia shaft fracture. The average hospital stay for the patients was 7 days and as compared to multi staged surgery financial burden was reduced by 40%. The average time of return to work for the patients was 3 weeks. Conclusion: Overall LRS proved to be an effective modality of treatment in cases of the lower extremity fracture with bone loss as definite modality of treatment for damage control as well as for achieving union and lengthening/transportation, deformity correction simultaneously, with the advantage of simple surgical technique, ease of application, minimal invasive, strong fixation, high patient compliance, early weight bearing, easy wound management, and the lower rate of complication.
Objective: Thoracic segmental anesthesia, as opposed to general anesthesia (GA), is increasingly preferred by anesthesiologists for laparoscopic cholecystectomy in both sick and healthy patients because it provides favorable operating conditions, a faster block time, and better hemodynamic stability. This study compared the efficacy of two different dosages of hyperbaric bupivacaine administered during segmental spinal anesthesia. Methods: In the current study, 54 American society of anesthesiologists Grade 1 and two patients undergoing elective laparoscopic cholecystectomy were randomly assigned to either Group A, which used 1.5 mL of hyperbaric bupivacaine mixed with 0.5 mL of fentanyl, or Group B, which used 2 mL of hyperbaric bupivacaine mixed with 0.5 mL of fentanyl. Primary objectives were to determine the onset and duration of the sensory and motor block, as well as height of sensory block. Determining the hemodynamic factors and complications were the secondary objectives. The mean, standard deviation, independent t test, Chi-square test, and p-value were used to calculate the data. p<0.05 was regarded as significant. Only some drugs were routinely given to the patient to manage their anxiety, discomfort, shoulder tip pain, etc., before, during, or after operation. Results: Onset of analgesia occurred in 2.5 min for Group A and 2.2 min for Group B. The sensory and motor blocks in Group B lasted longer than in Group A, but the differences were not statistically significant. No patients in either group reported any neurological complications, and there were no discernible differences between the two groups’ hemodynamic and respiratory dysfunctions. Despite some patients experiencing minor discomfort that was easily controlled by midazolam and ketamine in small doses, none of them required the conversion to GA. In two instances, Mephentermine was required to treat hypotension. In every patient, recovery went without a side effect. Conclusion: According to this preliminary study, laparoscopic surgery on healthy people can be performed with segmental spinal anesthesia using low doses of bupivacaine that is just as effective as high doses and present fewer complications.
Background: Preemptive analgesia is about the administration of an analgesic agent before the initiation of noxious stimulus, aiming of preventing sensitization of the neural system to successive stimulus that could intensify pain perception. Pregabalin is derivative of gabapentinoid which exhibits analgesic properties. Aims and Objectives: This clinical study designed to evaluate the effectiveness of pregabalin for post-operative analgesia in infraumbilical surgeries. Materials and Methods: This prospective clinical study was conducted in a medical college hospital of central India after obtaining approval from institutional ethics committee and informed written consent from the selected patients over the period of 1 year. A total of 60 patients between the ages of 20 and 40 years of ASA Grade I/II were randomly assigned into two groups (n=30, each) using an online randomization tool. Patients in Group P received oral Pregabalin 150 mg and Group D received oral Diazepam 10 mg, 1 h before induction of anesthesia. Both the groups uniformly received Tablet Paracetamol 1 gm, 2 h after completion of surgery. Patients experiencing pain with visual analogue scale (VAS) score ≥3, were injected Inj. Tramadol 100 mg, as rescue analgesia. Outcome variables such as need for rescue analgesia, sedation, VAS score, and other adverse events were noted at time intervals of 2, 4, 6, 12, and 24 h. Results: The mean VAS scores in patients of Group P were significantly lower than Group D (P<0.0001), over 24 h of post-operative period. In Group P, rescue analgesic Inj. Tramadol was given after 12.33±3.47 h as compared to 3.47±8.19 h in Group D (P<0.0001) with total need of 133.56±49.27 mg and 210.73±63.35 mg over 24 h in patients of Groups P and D, respectively (P<0.0001). Conclusion: Pregabalin 150 mg in pre-operative period provides superior post-operative analgesia and considerably reduces need of rescue analgesia postoperatively.
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